Alcohol As a Risk Factor For Injury

Intermediate Injury Prevention Course

Indian Health Service

Billings, Montana

August 2011

Alcohol As a Risk Factor for Injury

Goal: To understand the role that alcohol plays as a risk factor for injury, and it’s impact nationally as well as among American Indians and Alaska Natives.

Alcohol As a Risk Factor for Injury

Objectives:

Describe What We Know

Review Injury Data and Trends

Understand factors which place American

Indians and Alaska Natives at increased risk of alcohol-related injury

Alcohol, Injury, and American Indians

Common Belief: Alcohol is the cause of all problems in Indian country.

True or False:Alcohol is the leading risk factor for injuries.

The solution to injury is to abolish alcohol

Males have the greatest injury problem

The solution to injury is to eliminate males

PublicHealth Approach

Define the Problem

IdentifyRisk Factors

Find what Prevents

the Problem

Implement &Evaluate Programs

•Surveillance

•Who, What?

•What Works?

•Prevention

Source: National Center for Injury Prevention and Control, CDC

Alcohol and Injury

What Percent of American Indian and Alaska Native Deaths Are Alcohol-Related?

Sources: May P, The Epidemiology of Alcohol Abuse Among American Indians: the Mythical and Real Properties .

The Primary Care Provider, Volume 20, March 1995, Indian Health Service; . Ethnicity and Alcohol-Related Fatalities,

1990-1994, by Voas RB and Tipetts AS, National Highway Traffic Safety Administration, 1999.

Homicide

Suicide

Motor Vehicle

Pedestrian

— 85%

— 75%

— 73-65%

— 84%

American Indian Youth Risk Behavior Survey, 1997

1997 BIA/CDC Youth Risk Behavior Survey, students in grades 9-12:

48% Rode with Drinking Drivers 21% Drove after Drinking 37% Rarely/Never used Seat Belts 15% Attempted Suicide

Among American Indian/Alaska Natives adolescents aged 19 years and younger, motor vehicle crashes are the leading cause of injury-related death.

Motor Vehicle Fatality

Odds of Causing a Motor Vehicle Crash by BAC

05

10152025303540

0 .06 .08 0.1 0.12 0.14 0.16

BAC Percent

Rel

ativ

e R

isk

RF Borkenstein, The Role of the Drinking Driver in Traffic Accidents. Alcohol, Drugs and Behavior 1974; 2 (suppl) 8-32.

Motor Vehicle Fatality

In 2006, American Indian/Alaska Natives had the highest percentage (48%) of alcohol-impaired driving fatalities among all racial/ethnic populations.

Alcohol-Related Traffic Fatalities, 1982-2000, U.S.

Source: NHTSA, Fatality Analysis Reporting System

0

5,000

10,000

15,000

20,000

25,000

30,000

1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2005

Nu

mb

er o

f F

atal

itie

s

Year

Impact of Alcohol-impaired Driving, U.S.

• 115 million episodes

• Each DUI arrest: 1000-2000 not arrested

• 16,000 deaths

• 310,000 injuries

Each Year:

75

65

50

40

0

1020

3040

50

6070

8090

100

1990 2000

IndianAll U.S.

Source: NHTSA FARS Query system 2002: http://www-fars.nhtsa.dot.gov/; and Ethnicity and Alcohol-Related Fatalities, 1990-1994, by Voas RB and Tipetts AS, National Highway Traffic Safety Administration, 1999.

Are We Making a Difference?

Percent of Alcohol-Related Motor Vehicle Deaths, Native Americans and All US Races

Seat belt usage ranges from a low of 28% to a high of 88% on reservations.

Source: NHTSA. FARS data, 2006.

Risky Alcohol UseMeans Costly Health Problems

Predictors of seatbelt use in American Indian motor vehicle crash trauma victims on and off the

reservation.

Accid Anal Prev. 2007 Sep;39(5):1001-5. Epub 2007 Mar 28.

“…alcohol, rather than race or location, is the overriding predictor of seatbelt use. This study compared patients that were in crashes, and only those triaged to a level one trauma facility.”

Alcohol and American Indians

In groups of 2-3, discuss what you know are

factors that place American Indians/Alaska Natives at high risk for alcohol-related injury death. Take into consideration age, drinking style, environment, and gender.

Alcohol and American Indians

American Indians Overall are Younger

Median age of 24 vs. 33 for all US Races.

All Youth Engage More in Risky Behaviors

The large proportion of young AI/AN places a large segment of the population at risk

Risk Factor: Age

Alcohol and American Indians

In some Tribes, fewer adults drink than in the general US population, and a substantial proportion of Indian people do not drink, especially older adults.

Among AI/AN Who Do Drink—2-3 times Greater Prevalence of Problem Drinking

Risk Factor: Drinking Style

Alcohol and American Indians

Indian Males 15-35 Often “Binge” Drink with High BACs.

High BACs Often Lead to Severe Injury

Risk Factor: Drinking Style

Alcohol and American Indians

About Half of All American Indians Live in Rural Environments

Long Distances to Advanced Trauma Care

Risk Factor: Environment

Alcohol and American Indians

Risky Environments Such as Driving Long Distances at Night, Walking, and Boating Combined with High BACs Often Lead to Fatal Outcomes

Risk Factor: Environment

Alcohol and American Indians

More Indian Men Drink Than Women

Young Indian Men More Likely to Engage in Excessive Binge Drinking With High BACs

Risk Factor: Gender

Alcohol and American Indians

Indian Male Injury Death Rates are 2 to 5 Times Greater Than Female Rates

Indian Females Are at Higher Risk of Alcohol-Related Death than Non-Indian Women.

Risk Factor: Gender

Intervening in the Presence of Alcohol

Gallup Protective Custody Program Highway Lighting Projects: Whiteriver,

Gallup, Sells, others Float coat programs in Alaska Reduce Alcohol Availability--Policy Legislation and Enforcement of Laws

Intervening in the Presence of Alcohol

Protective Custody Program, Gallup, NM Intoxicated people picked up off streets and

housed up to 3 days Reduces potential pedestrian injuries,

hypothermia deaths, and violence Alcohol detoxification and treatment provided

Na’nizhoozhi Center

Intervening in the Presence of Alcohol

Successful street lighting projects in Whiteriver, AZ, Gallup, NM, Sells, AZ, and others

Pedestrian Lighting Projects

Allow drivers to see pedestrians at night, even if intoxicated and walking in roadway

Which of the Three “Es” is this approach?

Intervening in the Presence of Alcohol

• Alaska’s rivers are the “highways” of Native village life.

•The use of float coats and life jackets can save lives even in alcohol-related boating incidents.

Photo Source: Ryan Hill

Float Coat Programs

Who Controls Alcohol Policy?

Bootleggers

Border Towns

Tribal Council

Alcohol Policy Considerations

Long history of prohibition of American Indians and alcohol. American Indians could not legally buy alcohol until 1953.

Many tribes today are still “Dry” and don’t allow alcohol on the reservation.

Alcohol Policy Considerations

Buzz Group Discussion(5-7 min) List policy considerations (pros and cons) of tribes legalizing the sale of alcohol - ”Wet” and “Dry”. Half the class take the Wet policy and other half Dry.

Wet Dry

Pro

Con

Alcohol and Injury Summary

There are ways to be involved in reducing alcohol-related injuries in your community

Alcohol is a complex problem requiring multi-disciplined approach and community empowerment

Not just a police and court system problem

Alcohol Resources

• The Epidemiology of Alcohol Abuse Among American Indians: The Mythical and Real Properties by Dr. Philip May was published in the IHS Primary Care Provider, March, 1995, and can be found at:

• http://www.ihs.gov/publicinfo/publications/healthprovider/issues/IHSProMar2.asp#alcohol